Complementary Alternative Cardiovascular Medicine

110 Alternative Cardiovascular Medicine
incidence of death or CHF was 6% with carnitine vs 9.6% with placebo
[p = ns]. L-carnitine has been also studied in post-myocardial infarction
(MI) patients. Davini et al. (39) showed a significant decrease in mortality
with carnitine (1.2% vs 12.5%, p < 0.005) at 1-yr follow-up. However,
this was an open trial. Lack of blinding and higher number of
hypertensive patients in the control arm may make the results unreliable.
Carnitine also plays a protective role in patients with ischemic heart
disease. Corbucci et al. (40) demonstrated the absence of ischemic
changes in the carnitine group vs the control group in 120 patients undergoing
extracorporeal circulation (ECC) during aortopulmonary bypass
surgery. Levels of lactate, pyruvate, and succinate/fumarate ratio, reflective
of glycolytic cellular metabolism, were measured before and after
ECC. These levels remained in the normal range in patients with supplemental
carnitine when compared to the placebo group.
Several small, uncontrolled studies have noted a lower systemic vascular
resistance, an augmented ionotropic state, and enhanced lactate
extraction as a consequence of carnitine treatment (36). If confirmed,
these reported hemodynamic effects would suggest a role in CHF treatment.
It is well documented that carnitine deficiency causes dilated cardiomyopathy,
along with skeletal myopathy. In selected studies,
supplementation has led to significant responses. Mancini et al. (41)
studied 60 patients with CHF (EF < 50%, NYHA class II or III) for 180 d.
Patients received 500 mg/3 times a day of PLC or placebo. The only other
medications included digoxin and diuretics. There was significant improvement
in exercise times (increased by 26%) and ejection fractions (increased
by 14%). In an other larger study of 574 patients with heart failure and
EF < 40%, exercise tolerance was significantly improved in the carnitine
group when compared with placebo (42). However, the carnitine group
demonstrated a slightly higher mortality (3.0% vs 1.9%) and a higher
admission rate (6.3% vs 5.3%). Romagnoli et al. (43) studied the effects
of L-carnitine in patients undergoing dialysis. Their observational study
showed that L-carnitine addition to conventional therapy resulted in
overall improved clinical status, with increased mean ejection fraction
from 32% to 41.8 % (p < 0.05) and reduction in erythropoietin dosage.
Carnitine supplementation has also been noted to reduce the levels of
free FFA and triglycerides in clinical studies (44). However, the mechanism
is not clear. Larger clinical trails are needed to verify the lipidlowering
effects of carnitine.
Lower carnitine levels have been found in the muscle biopsies of
patients undergoing revascularization procedure for severe peripheral
vascular disease (PVD). In a double-blind, placebo-controlled, dosetitration,
multicenter trial, Brevetti et al. (45) have shown that active